Client Registration Form

Thank you for giving us the opportunity to be your veterinary clinic!

First name

Last name

Email

Check this box if you do not wish to be emailed appointment reminders, vaccine reminders, or other automated reminders.

Phone

Alternate Phone

Full Mailing Address

Are there other people with permission to make medical decisions? (spouse, adult child, pet sitter, etc) Please list them here. Must be over 18.

Please list all veterinary hospitals attended in the last 3 years so that we may request medical history and obtain vaccination history for your pets, or you may phone your previous veterinarian to request records be sent.

May we transfer records to other clinics (such as specialty centers) with your verbal permission if applicable?